Moralization of attachment: a fourth domain of conscience functioning

Conscience Relevance and Sensitivity in Psychiatric Evaluations in the Youth-span

Background:

While practice parameters recommend assessment of conscience and values, few resources are available to guide clinicians.

Objective:

To improve making moral inquiry in youth aged 15 to 24.

Method:

After documenting available resources for behavioral health clinicians who are inquiring about their patient’s moral life, we consider our studies of conscience development and functioning in youth. We align descriptions of domains of conscience with neurobiology. We compare youth reared in relative advantage, who have fairly smooth functional progressions across domains, with youth reared in adverse circumstances. We offer the heuristic conscience developmental quotient to help mind the gap between conscience in adversity and conscience in advantage. Next, we consider severity of psychopathological interference as distinct from delay. A case illustration is provided to support the distinction be

Results:

Our findings support the hypotheses that youth who experience adverse childhood experiences show evidence of fragmentation, unevenness and delay in their conscience stage-attainment. We demonstrate proof of concept for conscience sensitive psychiatric assessment in the youth-span. Conscience sensitive inquiries improve upon merely conscience relevant interpretations by affording better appreciation of moral wounding, in turn setting the stage for moral-imaginative efforts that elicit and make the latent values of the youth more explicit.

Conclusions:

A conscience sensitive approach should be part of both psychiatric and general medical education, supported explicitly by clinical guidelines recommending conscience sensitive interview techniques that aim to acquire information aligned with current neurobiological terminology.

The Role of the Relationship with Parents with Respect to Work Orientation and Work Ethic

We examined the extent to which individual relationships with mother and father, social support from partner, and quality of the relationship with the partner, are related to work orientation and work ethic. Survey data were obtained from 3841 respondents from the Netherlands Kinship Panel Study (wave 2). The results showed that, overall, people with a more positive relationship with their parents had a more positive work orientation and a stronger work ethic. A positive relationship with the father had a greater influence on these work aspects than a positive relationship with the mother, particularly for men. Partner support and the quality of the partner relationship partially mediated the association between the relationship with one's parents and work orientation only for women. There were no significant relationships between partner support or the quality of the partner relationship, and work ethic. Research on the relationship with parents and work-related variables is discussed.

Parental familism and antisocial behaviors: development, gender, and potential mechanisms

OBJECTIVE

To examine the relation between parental familism (strong values of attachment to nuclear and extended family members) and youth antisocial behaviors over time.

METHOD

Puerto Rican children 5 to 13 years of age at baseline residing in the South Bronx in New York (n = 1,138) and in the Standard Metropolitan Area in San Juan and Caguas, Puerto Rico (n = 1,353) were followed over two waves 1 year apart from 2000 to 2004. Parental familism was assessed using an adaptation of the Sabogal Familism Scale. Level of youth past-year antisocial behaviors was measured by the Antisocial Behavior Index. The association between familism and Antisocial Behavior Index over three waves was examined through mixed models stratified by age and gender, adjusted by site (South Bronx or San Juan), propensity scores reflecting site differences in family income, maternal age and education, plus environmental and child risk factors. Specific family processes were examined as potential mediators.

RESULTS

Parental familism was protective against antisocial behaviors in girls (estimate = -0.11, standard error = 0.03, p < .001 for 5- to 9-year-olds; estimate = -0.15, standard error = 0.03, p < .0001 for those ≥ 10 years old). For boys, parental familism was only protective in 5- to 9-year-olds (estimate = -0.09, standard error = 0.03, p = .0008). The protective effect of parental familism on antisocial behaviors operated mostly through parent-child relationships for 5- to 9-year-old children and parental attitudes/behaviors toward youth high-risk behaviors for both age groups.

CONCLUSIONS

Familism may protect youth against increasing levels of antisocial behaviors (except for boys who are ≥ 10 years old). Incorporating familism as part of therapeutic approaches addressing antisocial behaviors for youth may be helpful.

[Prosocial personality. Why is cooperation and moral adjustment the rule?]

Human beings are adapted for acting and thinking cooperatively in cultural groups and the most impressive cognitive achievements of humans are the products not of individuals acting alone but of individuals interacting. As they grow, human children are equipped to participate in this cooperative group thinking through a special kind of cultural intelligence, comprising species-unique social-cognitive skills and motivations for collaboration, communication, social learning and other forms of shared intentionality. Some mechanism of social learning and norm orientation are reported, leading to some presumptions about the roots of antisocial behavior.

[Development, basic characteristics and empirical norms of the DSQ-40 psychological test]

Psychological defence mechanisms represent relatively stable aspect of personality, while character and frequency of defence mechanisms which a person uses, points to the character structure of personality. Measuring psychological defence mechanisms is very difficult and very unreliable, so that only several instruments have been developed for the estimation of such characteristics. The most notable instrument of this kind in the world is DSQ-40 (Defense Style Questionnaire), which has lately been more often used in our country. As DSQ-40 is still not widely known in our environment, the aim of this study was to represent the onset and the development of this test, its basic characteristics and empirical norms acquired on our population. Examination included two examined groups in military population of male sex only: soldiers of adolescent age (n = 400) and officers of the adult age (n = 165). Statistical analysis and the comparison of the results with corresponding standards obtained in foreign researches showed that defence style and structure of psychological defence mechanisms were connected with socio-demographic and cultural characteristics of examinees. It was concluded that norms of the test DSQ-40 must be adjusted to the concrete population, which hasn't diminished its practical values and employment in diagnostic and selection purposes.

Attention Deficit Hyperactivity Disorder

Management of attention deficit hyperactivity disorder (ADHD) encompasses two general domains: pharmacologic therapies and nonpharmacologic therapies, including educational, cognitive-behavioral, and other psychological and psychiatric approaches. Within the past year there have been two seminal developments in treatment. The first is that the Evidence-based Practice Center at McMaster University, under contract with the Agency for Health Care Policy and Research, produced an evidence based report on the treatment of ADHD. The topic was proposed to the AHCPR by the American Academy of Pediatrics and American Psychiatric Association, who served as partners to the center. The second is the completion of the Multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA) study by the National Institutes of Mental Health, a 14-month double-blind placebo trial of medication and behavioral therapy in ADHD. In general, the result of the evidence-based review and the MTA study is that stimulants are the most effective agents for the treatment of ADHD. Results from the MTA study indicate that methylphenidate (MPH) and MPH combined with behavioral therapy are superior to behavioral therapy alone and that all three are superior to community therapy. The evidence-based review indicates that each of the stimulants is superior to placebo and the stimulants (regular and sustained-release MPH as well as d and l isomers of the stimulants) are comparable. As for other agents, tricyclic antidepressants, specifically desipramine, are superior to placebo. Only a few studies compared stimulants directly with tricyclic antidepressants, and these were technically inadequate, leading to the conclusion that more rigorous studies are required. Only five studies were found that examined nonpharmacologic treatment, and all contained major limitations in methodology. Despite the limitations, all showed that stimulants were more effective than the nonpharmacologic therapies, consonant with the results of the MTA study. There was lack of evidence to support the superiority of combination multimodal treatment over stimulant therapy alone, again consonant with the MTA study. Both the evidence-based review and the MTA study examined ADHD in middle childhood. Finally, most studies are relatively short-term, including the MTA study (at 14 months). Some evidence suggests that MPH reduces behavioral disturbance as long as it is taken.

Moral volition: the fifth and final domain leading to an integrated theory of conscience understanding

OBJECTIVES

To define discrete developmental levels of understanding of the ways in which normal children and adolescents link autonomy and will to moral obligation and to study the correlation between this progression and previously identified stages of conscience conceptualization.

METHOD

One hundred thirty-two normal volunteers between the ages of 5 and 17 years were individually interviewed using the moral volition section of the semistructured Stilwell Conscience Interview. Analysis of the interviews resulted in five levels of understanding of moral self-evaluation and volitionally chosen behavior.

RESULTS

Analyses of variance and covariance showed that the five levels of moral volition had significant correlation with five conceptualization stages, with stage criteria showing a stronger correlation than age. Self-identified tasks of oughtness were hierarchically defined beginning with those defining a morality of restraint followed by moralities of mastery/sufficiency, virtuous striving, idealization, and individual responsibility. Perception of increased independence of self in interaction with conscience was noteworthy at stages 4 and 5.

CONCLUSIONS

Moral volition is the domain of conscience functioning that defines understanding of moral self-evaluation and volitionally chosen actions; five levels of understanding can be demonstrated in normal children between the ages of 5 and 17 years.